Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMPHIPHYSIN ANTIBODY TEST

Facility

$1,925.00

Service Code	HCPCS 84181
Hospital Charge Code	3038553
Hospital Revenue Code	301
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

AMPHOJEL/300MG/TAB

Facility

$3.00

Hospital Charge Code	60632452
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

AMPHOJEL/300MG/TAB

Facility

$3.00

Hospital Charge Code	60632452
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

AMPHOTER B LIPID CMP 100MG

Facility

$1,081.00

Service Code	HCPCS J0286
Hospital Charge Code	6016570
Hospital Revenue Code	636
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$540.50
Rate for Payer: Aetna Commercial	$410.78
Rate for Payer: Aetna Medicare Advantage	$324.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.65
Rate for Payer: Cigna Commercial	$540.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.60
Rate for Payer: Qualcare PPO/HMO/WC	$162.15
Rate for Payer: UnitedHealthcare Community & State	$26.05
Rate for Payer: Wellpoint Medicaid Managed Care	$28.65

AMPHOTER B LIPID CMP 100MG

Facility

$1,081.00

Service Code	HCPCS J0286
Hospital Charge Code	6016570
Hospital Revenue Code	636
Min. Negotiated Rate	$162.15
Max. Negotiated Rate	$261.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.60
Rate for Payer: Qualcare PPO/HMO/WC	$162.15

AMPHOTER B LIPID CMP 100MG

Facility

$735.00

Service Code	HCPCS J0286
Hospital Charge Code	60627244
Hospital Revenue Code	636
Min. Negotiated Rate	$17.71
Max. Negotiated Rate	$367.50
Rate for Payer: Aetna Commercial	$279.30
Rate for Payer: Aetna Medicare Advantage	$220.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.43
Rate for Payer: Cigna Commercial	$367.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.87
Rate for Payer: Qualcare PPO/HMO/WC	$110.25
Rate for Payer: UnitedHealthcare Community & State	$17.71
Rate for Payer: Wellpoint Medicaid Managed Care	$19.48

AMPHOTER B LIPID CMP 100MG

Facility

$735.00

Service Code	HCPCS J0286
Hospital Charge Code	60627244
Hospital Revenue Code	636
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$177.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.87
Rate for Payer: Qualcare PPO/HMO/WC	$110.25

AMPHOTER B LIPID CMP INJ 100MG

Facility

$1,608.00

Service Code	HCPCS J0287
Hospital Charge Code	6016588
Hospital Revenue Code	636
Min. Negotiated Rate	$38.75
Max. Negotiated Rate	$804.00
Rate for Payer: Aetna Commercial	$611.04
Rate for Payer: Aetna Medicare Advantage	$482.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.04
Rate for Payer: Cigna Commercial	$804.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.14
Rate for Payer: Qualcare PPO/HMO/WC	$241.20
Rate for Payer: UnitedHealthcare Community & State	$38.75
Rate for Payer: Wellpoint Medicaid Managed Care	$42.61

AMPHOTER B LIPID CMP INJ 100MG

Facility

$1,608.00

Service Code	HCPCS J0287
Hospital Charge Code	6016588
Hospital Revenue Code	636
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$389.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.14
Rate for Payer: Qualcare PPO/HMO/WC	$241.20

AMPHOTERICIN B 50 MG INJ

Facility

$402.00

Service Code	HCPCS J0285
Hospital Charge Code	6000426
Hospital Revenue Code	636
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$97.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.28
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

AMPHOTERICIN B 50 MG INJ

Facility

$402.00

Service Code	HCPCS J0285
Hospital Charge Code	6000426
Hospital Revenue Code	636
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$152.76
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.28
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

AMPHOTERICIN B INJ/50MG

Facility

$74.00

Hospital Charge Code	60634521
Hospital Revenue Code	636
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$37.00
Rate for Payer: Aetna Commercial	$28.12
Rate for Payer: Aetna Medicare Advantage	$22.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.87
Rate for Payer: Cigna Commercial	$37.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.91
Rate for Payer: Qualcare PPO/HMO/WC	$11.10
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.96

AMPHOTERICIN B INJ/50MG

Facility

$74.00

Hospital Charge Code	60634521
Hospital Revenue Code	636
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$17.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.91
Rate for Payer: Qualcare PPO/HMO/WC	$11.10

AMPICILLIN 250 MG CAP

Facility

$4.00

Service Code	NDC 781214401
Hospital Charge Code	60627298
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

AMPICILLIN 250 MG CAP

Facility

$4.00

Service Code	NDC 781214401
Hospital Charge Code	60627298
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMPICILLIN 500 MG CAP

Facility

$4.36

Service Code	NDC 781214501
Hospital Charge Code	60627300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

AMPICILLIN 500 MG CAP

Facility

$4.36

Service Code	NDC 781214501
Hospital Charge Code	60627300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.66
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.31
Rate for Payer: Oxford Commercial	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.65
Rate for Payer: UnitedHealthcare Commercial	$0.87
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

AMPICILLIN ADDV/1G

Facility

$21.00

Hospital Charge Code	60634453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

AMPICILLIN ADDV/1G

Facility

$21.00

Hospital Charge Code	60634453
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

AMPICILLIN ADDV/2G

Facility

$43.00

Hospital Charge Code	60634454
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

AMPICILLIN ADDV/2G

Facility

$43.00

Hospital Charge Code	60634454
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

AMPICILLIN ADDV/500MG

Facility

$21.00

Hospital Charge Code	60634452
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

AMPICILLIN ADDV/500MG

Facility

$21.00

Hospital Charge Code	60634452
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

AMPICILLIN CAP 250MG

Facility

$1.95

Hospital Charge Code	6023089
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

AMPICILLIN CAP 250MG

Facility

$1.95

Hospital Charge Code	6023089
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

Know your out-of-pocket cost for care.

All Charges